Adoption Application

Household Information

Street Address*

Apt, Suite, Unit (optional)

City*

State*

ZIP*

How long at above address?*

Applicant #1

Name*

SSN*

Email*

Cell Number*

Date of Birth*

Place of Birth*

Are you a U.S. citizen?*

YesNo

Race*

Religion*

Highest Educational Degree Obtained*

College & Degree Area (optional)

Occupation*

Employer*

Work Phone*

Length of Employment*

Annual Income*

$

Applicant #2

Name*

SSN*

Email*

Cell Number*

Date of Birth*

Place of Birth*

Are you a U.S. citizen?*

YesNo

Race*

Religion*

Highest Educational Degree Obtained*

College & Degree Area (optional)

Occupation*

Employer*

Work Phone*

Length of Employment*

Annual Income*

$

Background Details

Date of Marriage*

Place of Marriage*

Have either of you been previously married?*

YesNo

Do you have children living in your home?*

YesNo

Does anyone else live in your home (adult family members, etc)?*

YesNo

In the last 10 years, have either of you resided in any state other than your current state of residence?*

YesNo

Have you previously adopted a child?*

YesNo

Have either of you ever been convicted for violation of any law (including expungements) or are you currently under charges for any violation?*

YesNo

Have either of you ever been diagnosed with a mental illness or addiction?*

YesNo

Have either of you received counseling?*

YesNo

Adoption Details

Type of adoption you wish to pursue*

DomesticInternationalIndependentEmbryo

How did you learn about Adoption Assistance?*

Signatures

The above data is true and complete to the best of my/our knowledge. We are aware that falsification of information or misrepresentation of facts will result in rejection of our application.*

I agree

Electronic Signature:By typing each applicant's full name below, you are signing this application electronically. These signatures carry the same legal weight as handwritten signatures.

Applicant #1 Full Name*

Your typed name serves as your legal signature.

Date*

Applicant #2 Full Name*

Your typed name serves as your legal signature.

Date*

Choosing Adoption

Birthparents FAQs

Birthparent Services

Birthparent Stories

Intake Forms

Our Process

Domestic Adoption

International Adoption

Embryo Adoption

Adoption Stories

Meet the Team

FAQs

How to Adopt a Child from Foster Care: A Step-by-Step Guide for Families in Kentucky, Tennessee, and Indiana

How to Adopt from Foster Care in Kentucky, Tennessee, and Indiana: A Complete 2026 Guide

Online Application

Household Information

Applicant #1

Applicant #2

Background Details

Adoption Details

Signatures

By entering your names above you are signing this application

Louisville, KY

Danville, KY

Nashville, TN

New Albany, IN